This blog is about the evaluation and treatment of trauma and attachment disorders. It focuses on Dyadic Developmental Psychotherapy; the effective and evidence-based treatment for trauma and attachment disorders.

May 31, 2009

Temperament is a largely genetically determined set of characteristics that remain unchanged from birth throughout life. Beginning as early as four months of age, a child’s temperament can be determined. These temperamental traits are largely unchanged throughout life. Understanding temperament is important since these personality traits do not change. A parent needs to understand these dimensions so that the parent can adapt to the child.

Temperament refers to enduring traits of a person’s approach to the world. These dimensions are found in all children across cultures. A child’s temperament is a core element of the child’s personality. Since it is unchangeable, understanding temperament is essential to knowing how to approach your child. What may appear to be a problem may actually be a mismatch between your temperament and that of your child.

2. REGULARITY: The predicable recurrence of a child’s response to daily events. The rhythm of their body functions such as sleeping, eating, elimination. In school age children, regularity is observed as consistency, organization, or predictability. Is the child orderly with toys and possessions? Is the child’s after-school routine the same each day?(Predictable or Unpredictable).

3. INITIAL REACTION: The child’s reaction to new people, places, things, foods, and routines. For example, tries new foods, refuses, or looks it over, pokes it, and then tries a bite.(Bold or Inhibited; Approaching or Cautious).

4. ADAPTABILITY: Like initial reaction, but refers to the child’s long-term adjustment after the initial response. The ease or difficulty with which the child’s first reaction can be changed. How quickly does the child make transitions or adapt to changes in routine? How quickly can the child make a choice? How does the child react to last minute changes?(Flexible or Rigid; Quick or Gradual).

5. INTENSITY: How much energy the child puts into a response. Is the child loud? How does the child respond to disappointments, praise, failure, surprise, or frustration?(Intense or mild).

6. MOOD: What is the child’s dominant mood or overall pattern? Is the child generally positive, negative, or in between?(Positive or Negative).

7. DISTRACTIBILITY: Is the child able to tune out surrounding sights, sounds, or people and continue without interruption or is the child distracted by outside stimuli? This is not the same as persistence. A child can be easily distracted yet return immediately to the task at hand and stick with it until it is completed. How quickly can a baby be soothed?(Rarely or Often)

8. PERSISTENCY AND ATTENTION SPAN: Persistency is the child’s tendency to stick with an activity despite interruptions or outside distractions. Attention span is demonstrated by how long a child sticks with an activity when there are no interruptions.(Often or Rarely; Persistent or not; Short or long).

9. SENSITIVITY: Sensory threshold or the amount of stimulation required to get a response. Watch all five senses (sight, hearing, touch, smell, taste).(Nonreactive or Sensitive).

TEMPERAMENT CHECKLIST

Temperament is composed of nine dimensions. Temperament is easily determined at birth and does not change; it appears to be genetically determined. Temperament can be thought of as one of the basic elements of personality that is not changeable. It is not right or wrong, it just is; although temperaments different than one’s own can seem to be “wrong,” they are not. At the Center we use the Cary Temperament Scales to measure a child’s temperament and provide parents with a report detailing their child’s temperament and the potential strengths and pitfalls that the parent and child may experience. The traits on each continuum are neither good nor bad. However, mismatches between a parent’s and child’s temperament can create discord and problems. The following check list is not meant to replace a professional assessment or to substitute for a reliable and valid test such as the Cary. However, this check list can help you identify areas of match and mismatch between your temperament and that of your child.

The fact that you have temperament traits on the other side of a scale item form your child, or spouse for that matter, does not mean that a problem exists. It merely means that you and your child have different temperaments on that dimension. It does mean that as a parent you do need to be particularly sensitive to that dimension since your proclivities and those of your child are different. However, as a parent it is your responsibility to adapt to these differences and accommodate your child. Knowing that you and your child differ on a dimension of temperament, which is not a changeable dimension of personality, allows the parent to know that he or she must adapt to the child. This also can help a parent realize that when a child is “pushing” your buttons, that it is your issue and not something that your child should be expected to change. When there are significant differences in parent-child temperament, the parent will need to take extra steps to be sure that he or she adapts to the child.

May 20, 2009

Josh Lechter, assistant director of child care for the Community-Based Acute Treatment program at Walker, has written a paper featured in the most recent issue of Refocus, the Residential Child Care Project newsletter published by Cornell University.tci

His paper, Using TCI’s Family Care Provider Training To Break Down Language Barriers Between Residential Treatment and Life at Home, discusses the success of a new initiative at Walker to share therapeutic crisis intervention training and techniques with the families of Walker students.

Therapeutic Crisis Intervention For Family Care Providers (TCIF) is a curriculum-based class adapted from the same crisis prevention and behavior management skills taught to The Walker School staff. Developed by the The Family Life Development Center at Cornell University, the 5-day course involves modeling and role playing to familiarize family members with strategies and techniques for deescalating problems and emotionally volatile situations with their children at home. According to the developers at Cornell, Walker is the first organization to offer TCIF training to the families of children with serious emotional and behavior issues.

Judging from the enthusiastic response of participating families, the availability of this specialized training for parents and caregivers will help to improve the likelihood of a child’s successful transition from residential treatment to home and community. In the paper, Lechter recounts the comments of several grateful parents, including one who said, “the course was a blessing. I now do not feel alone in helping my children with their mental health needs.”See this article for more detailshttp://www.walkerschool.org/upload/REFOCUS_VOL_14.pdf

Noah felt like he was always hitting the books. While his friends were meeting for pickup soccer games after school, he was back home in his room reading and rereading the same material. But no matter how hard Noah studied, he had difficulty remembering things and his grades stayed average. Meanwhile, his friend Sean, who never seemed to study, always aced tests. It didn't seem fair.

Because Noah was so frustrated, his dad and teachers made an appointment with the school psychologist. She diagnosed Noah with a learning disability. Although Noah felt relieved to know what was going on, he was also worried. He didn't like the "disability" label. And he was concerned about what it might mean for his future. Would he be able to go to college and study engineering as he'd hoped?

What Are Learning Disabilities?

For someone diagnosed with a learning disability, it can seem scary at first. But a learning disability doesn't have anything to do with a person's intelligence - after all, such successful people as Walt Disney, Alexander Graham Bell, and Winston Churchill all had learning disabilities.

Learning disabilities are problems that affect the brain's ability to receive, process, analyze, or store information. These problems can make it difficult for a student to learn as quickly as someone who isn't affected by learning disabilities. There are many kinds of learning disabilities. Most students affected by learning disabilities have more than one kind. Certain kinds of learning disabilities can interfere with a person's ability to concentrate or focus and can cause someone's mind to wander too much. Other learning disabilities can make it difficult for a student to read, write, spell, or solve math problems.

The way our brains process information is extremely complex - it's no wonder things can get messed up sometimes. Take the simple act of looking at a picture, for example: Our brains not only have to form the lines into an image, they also have to recognize what the image stands for, relate that image to other facts stored in our memories, and then store this new information. It's the same thing with speech - we have to recognize the words, interpret the meaning, and figure out the significance of the statement to us. Many of these activities take place in separate parts of the brain, and it's up to our minds to link them all together.

If, like Noah, you've been diagnosed with a learning disability, you're not alone. Nearly four million school-age children and teens have learning disabilities, and at least 20% of them have a type of disorder that makes it difficult to focus.

What Are the Signs of Learning Disabilities?

You can't tell by looking that a person has a learning disability, which can make learning disabilities hard to diagnose. Learning disabilities typically first show up when a person has difficulty speaking, reading, writing, figuring out a math problem, communicating with a parent, or paying attention in class. Some kids' learning disabilities are diagnosed in grade school when a parent or a teacher notices a kid can't follow directions for a game or is struggling to do work he or she should be able to do easily. But other kids develop sophisticated ways of covering up their learning issues, so learning disabilities don't show up until the teen years when schoolwork - and life - gets more complicated.

Most learning disabilities fall into one of two categories: verbal and nonverbal.

People with verbal learning disabilities have difficulty with words, both spoken and written. The most common and best-known verbal learning disability is dyslexia, which causes people to have trouble recognizing or processing letters and the sounds associated with them. For this reason, people with dyslexia have trouble with reading and writing tasks or assignments.

Some people with verbal learning disabilities may be able to read or write just fine but they have trouble with other aspects of language. For example, they may be able to sound out a sentence or paragraph perfectly, making them good readers, but they can't relate to the words in ways that will allow them to make sense of what they're reading (such as forming a picture of a thing or situation). And some people have trouble with the act of writing as their brains struggle to control the many things that go into it - from moving their hand to form letter shapes to remembering the correct grammar rules involved in writing down a sentence.

People with nonverbal learning disabilities may have difficulty processing what they see. They may have trouble making sense of visual details like numbers on a blackboard. Someone with a nonverbal learning disability may confuse the plus sign with the sign for division, for example. Some abstract concepts like fractions may be difficult to master for people with nonverbal learning disabilities.

A behavioral condition called attention deficit hyperactivity disorder (ADHD) is often associated with learning disabilities because people with ADHD may also have a hard time focusing enough to learn and study. Students with ADHD are often easily distracted and have trouble concentrating. They may also be excessively active or have trouble controlling their impulses.

What Causes Them?

No one's exactly sure what causes learning disabilities. But researchers do have some theories as to why they develop. They include:

Genetic influences. Experts have noticed that learning disabilities tend to run in families and they think that heredity may play a role. However, researchers are still debating whether learning disabilities are, in fact, genetic, or if they show up in families because kids learn and model what their parents do.

Brain development. Some experts think that learning disabilities can be traced to brain development, both before and after birth. For this reason, problems such as low birth weight, lack of oxygen, or premature birth may have something to do with learning disabilities. Young children who receive head injuries may also be at risk of developing learning disabilities.

Environmental impacts. Infants and young children are susceptible to environmental toxins (poisons). For example, you may have heard how lead (which may be found in some old homes in the form of lead paint or lead water pipes) is sometimes thought to contribute to learning disabilities. Poor nutrition early in life may also lead to learning disabilities later in life.

How Do You Know If You Have a Learning Disability?

Just because you have trouble studying for a test doesn't mean you have a learning disability. There are as many learning styles as there are individuals. For example, some people learn by doing and practicing, others learn by listening (such as in class), and others prefer to read material. Some people are just naturally slower readers or learners than others, but they still perform well for their age and abilities. Sometimes, what seems to be a learning disability is simply a delay in development; the person will eventually catch up with - and perhaps even surpass - his or her peers.

But many people with learning disabilities struggle for a long time before someone realizes that there's a reason they're having so much trouble learning. For most people in their teen years, the first telltale sign of most learning disabilities occurs when they notice that there's a disconnect between how much they studied for a test and how well they performed. Or it may just be a feeling a person has that something isn't right. If you're worried, don't hesitate to share your thoughts with a parent or a teacher.

The first step in diagnosing a learning disability is ruling out vision or hearing problems. A person may then work with a psychologist or learning specialist who will use specific tests to help diagnose the disability. Often, these can help pinpoint that person's learning strengths and weaknesses in addition to revealing a particular learning disability.

Coping With a Learning Disability

Although a diagnosis of a learning disability can feel upsetting, it's actually the first step in resolving the condition. Once an expert has pinpointed a person's particular problem, he or she can then follow strategies or take medicines to help cope with the disability. And taking steps to manage the disability can often help restore a student's self-esteem and confidence.

Some students who have been diagnosed with a learning disability work with a special teacher or tutor for a few hours a week to learn special study skills, note-taking strategies, or organizational techniques that can help them compensate for their learning disability. If you've been diagnosed with a learning disability, you may need support just for the subjects that give you the most trouble. Your school may have a special classroom with a teacher who is trained to help students overcome learning problems.

Some schools develop what is called an Individualized Education Program (or IEP), which helps define a person's learning strengths and weaknesses and make a plan for the learning activities that will help the student do his or her best in school. A student's IEP might include some regular time with a tutor or in a specialized classroom for a certain subject, or the use of some special equipment to help with learning, such as books on tape or laptop computers for students who have dyslexia.

Medication is often prescribed to help students with ADHD. There are several medicines on the market today to help improve a student's attention span and ability to focus and to help control impulses and other hyperactive behavior.

There's no cure for a learning disability. And you don't outgrow it. But it's never too late to get help. Most people with learning disabilities learn to adapt to their learning differences, and they learn strategies that help them accomplish their goals and dreams.

May 9, 2009

This is a review of two excellent books for educators, parents, social workers, psychologists, and therapists.

The first book, Attachment in the Classroom by Heather Geddes, (2006), London: Worth Publishing, is a superior resource and should be on your book shelf. The subtitle says it all, “The links between children’s early experience, emotional well-being and performance in schools.” In this book, Dr. Geddes uses the research categories of patterns of attachment (secure, avoidant, ambivalent, and disorganized) to describe how each pattern affects a child’s ability to function in the classroom, use the teacher, and approach the task at hand. She offers extensive examples from the classroom and provides specific suggestions for educators to use for each pattern of attachment. The book should be of general utility to many teachers, not just special education teachers or those who work with children with Reactive Attachment Disorder. This is the real beauty of the book: its general utility as an approach to pedagogy.

Dr. Geddes begins by describing “The Learning Triangle,” which is the relationships among teacher, pupil, and task. Her chapter, “Behavior has meaning,” is a wonderful description of how and why it is vital to focus on the cause, motivation, or driver of behavior and not merely the surface behavior. Dr. Geddes chapter, “Outline of Attachment Theory,” is a good refresher for those who know Attachment Theory and an excellent introduction for those new to it. Her next several chapters on avoidant attachment, ambivalent attachment, and disorganized attachment in the classroom are wonder. Her use of examples, explanations of behavior, and then the provision of specific suggestions and recommendations for teachers will be very helpful for parents, educators, and those who work with educators. She presents clear recommendations that are soundly connected to each attachment style’s pattern of relating. I have been able to use this material in my work with schools with great success. Dr. Geddes as an educator herself provides enormous credibility for this work with school personnel.

I found this book to be very readable and wonderfully informative. I can, without reservation, recommend it to parents, therapists, and educators.

The second book want to recommend to you is, “Learn the Child,” by Kate Cairns and Chris Stanway, (2007), London: British Association for Adoption and Fostering. This book will be of interest primarily to educators and those who train educators. The book begins with an overview of the issues presented by “looked after children,” (British for children in care) and is primarily about UK laws and their evolution and impact on education. However, there are several very detailed case-studies of children in care and how they functioned in educational settings. These case examples will be familiar with anyone who works in our field and highlight the impact on educational processes of chronic early maltreatment. The bulk of the book is a set of forty-eight PowerPoint slides with detailed explanations of each slide. This is the part of the book I found most useful. While the material may be familiar to many of us, it is presented in a format that is easy to understand and that will be very helpful for educators and educational administrators and policy makers. I can envision using this material in presentations to school personal, special education staff, the education staff at residential treatment centers, and policy makers and administrators. The book comes with the PowerPoint slides on a CD for easy of use. Also included in the CD are the case examples, handouts, and other useful material.

While the book is narrow in focus, it should be on the book shelf of anyone who regularly provides training for educators, administrators, and policy makers. The book is expensive, 33.75 pounds, including shipping, but I think it is worth it.

May 5, 2009

Generally, infants adopted before the age of six months fare no differently than infants raised from birth. However, after six months, the effects of institutional care begin to emerge. It is important to realize that even the best orphanages are not good places to raise a child. In NY state the infant-care giver ratio required by regulation for infant day care is no more than two infants per care provider...so 5:1 is better than 10:1, but still it won't help the child develop a normal, healthy, and secure attachment to a specific figure, which is what the attachment system is supposed to do. Several visits during a year won't make much of any difference on your child's development or on this most important process.

That being said, it is also important to remember that children are rather "plastic" and that attachment develops during the first two to three years of life. So, you will need to do some work when you bring your child home to make up for the early deprivations that your child has experienced.1. It is best to make the room as similar to the orphanage as possible to make for an easier transition.2. Serve the same foods at first.3. Keep ALL others at a distance for the first several weeks to months so your child develops a specific and unique bond with you.4. It would be best for you to spend the first two to three months at home constantly with the child; carrying the child and physically being present to meet the child's needs and to develop a affectively attuned relationship that will allow you to anticipate your child's needs and meet those, as well.

1) YOU, AND ONLY YOU, WEAR YOUR BABY!! Carry them with you wherever you go, and whatever you do. (Unless dangerous) Attach them to your bodies. A great baby carrier is one that the baby can have skin to skin contact with you – Baby Trekker (1-800-665-3957) is a good one. Carry the baby on your hip; tie to your body under a sweatshirt, front carrier, or in your arms. The more contact the better. These babies were not held enough. Hold Them!!!! A LOT!!! ALL THE TIME!!!! For the rare times the baby is not in your arms, have them in the same room as you are in.

2) YOU ARE THE ONLY CAREGIVER!! You always bottle, feed, bath, dress, change and most of the play. If friends and family want to help let them walk the dog or clean your house, wash bottles or do laundry, bring food or make you tea. No baby-sitters and no sending the baby away for respite. Until your baby is firmly emotionally attached to you, NO ONE the baby doesn't see daily should hold or even touch him or her, and even those that the baby sees daily should hold him or her at a very minimum.

3) KEEP THE BOTTLE AS LONG AS POSSIBLE –EVEN LONGER! You, not the baby, hold the bottle. You can hold the bottle with your chin so you have two hands to snuggle your baby close to you. One handed it also fine. Hold the child the way a nursing mother does – chest to chest, close to you with as much skin-to-skin contact as possible. Look your baby in the eyes and when they do, instantly put the bottle in their mouth and tell them good job!! Keep looking at their eyes so when they are ready for eye contact, you don't miss it. Note: some babies with sensory-integration difficulties may find eye contact too stimulating and it may actually be disruptive to the child.

5) A LOT OF FACE-TO-FACE baby games and funny faces and TONS of smiles and kisses!! Paint bright circles around your eyes. Close one eye, then the other, rapidly blink, and then change speeds, all the time with funny noises. Cover both eyes then one, and so on. Have the baby sit on your lap, and if this is too hard for them at first, lay them on a bed to do it. Then slowly trick them into letting you touch and hold them!! Keep it fun for them.

6) WHEN THERE IS A GREAT DEAL OF ANGER OR AVOIDANCE, the baby NEEDS to experience comfort, safety, and security. They feel so far away from you, and have to be brought closer to heal. Cradle the baby in your arms. Have their arm closest to you held close. Talk soothingly to them, and tell them to look in mommy's eyes. They have been ignored, hit, or yelled at in the orphanage. That is why it is SO IMPORTANT this ALL be done in an extremely loving way. Never squeeze the baby too close, speak harshly, lose your cool or forget why you are doing this. If you get to feel their anger, immediately put them down and call support. You have to remain supportive, yet expect their best. They may try to hit you, scratch, bite, scream and get to you any way they can. Their intense rage is there. Yes, even little babies. Eye contact, feeling safe, and being accepted no matter what in a loving way is the goal here. For whatever reason, they have shut off people. Now they need YOU to heal. Rub them, soothe them in singing, and soft speech, rock them and tell them you love them. Keep it up until they will calm down and look in your eyes and FEEL connected to you. At times they will fall asleep screaming. If so, and if possible, continue to hold them until they wake up, and then continue above. If you need to lay them down, have a monitor on so you can pick them up as soon as they wake up. For the very avoidant baby one unsolicited eye contact a week could be considered good! Keep it up; you have several good eye contacts a minute to look forward to! Remember, you did not create this anger in your baby.

7) NOW IS THE BEST AND EASIEST TIME TO WORK WITH YOUR BABY.

8) DO A LOT OF BABY MASSAGES. For the real avoidant baby, a half-hour. Each day you delay, the harder it is for them and you. Attachment issues do NOT just go away on their own. They only get worse. Twice a day would be minimum. All the time talk, sing and let that baby know how special they are!! Most of the babies seem to really enjoy this, and my daughter would even get out the lotion as soon as she could reach for it!!

9) ROCK THAT BABY!! They often can't stand you sitting in a rocking chair, but can often tolerate and enjoy you walking and dancing with them in your arms. (Remember face-to-face contact during this) Gentle motion, bouncing and rocking are a must!!

10) SLEEP WITH THE BABY. If you can, the best is to have the baby in your bed close to you. Second choice is to have the baby in their crib right next to your side of the bed with the side rail down. Have the crib touching snug to your bed, so if they climb out, they climb safely onto you!! They need t hear your breathing and know you are close. Yet for someone over one, you get special permission (in writing) to have him or her sleep in your room for mental health reasons. Should not be a big problem. Have the baby always fall asleep in your arms. Nap or night. They need to get used to feeling loved!!

11) SING, SING, SING!!! It lightens the load, and helps the baby feel the happy friendliness they missed out on. Joyful voices are so important!

12) ENCOURAGE EYE CONTACT WHEN FEEDING, BOTTLING, TALKING, CHANGING, AND ALL THE TIME!! Not coerced or forced, but loving eyes.

13) EXPECT A DIRTY HOUSE, soup out of the can and sandwiches for supper and piles of laundry. Know that you are not super mom, and that baby can't wait until all is in order to get on with their lives. Here is where all those well-meaning friends that want to hold that precious baby come in!! Let them work!!!

14) EXPECT TO BE CRITICIZED AND ACCUSED as over possessive, spoiling the baby, and making more than you should out of the baby's problems. You will be told all babies do that. This is by well meaning friends, neighbors, relatives, doctors, and social workers. Stick to what YOU KNOW the baby needs, and fight to get that for them. Remember YOU know that baby more than anyone else.

15) HAVE A GREAT SUPPORT SYSTEM. Have a trusted friend (hopefully someone who has had experience in attachment disorder) that you can call without being told you are making too much of it. Read books on attachment disorder. Know what dangers await that baby if they are not helped. Working with an infant or toddler has such a HUGE chance for success!! Not one act of kindness is wasted.

16) GET AN OFFICIAL EVALUATION BY AN ATTACHMENT EXPERT.That way in court and with workers you do have leg to stand on in getting these babies what they need!!! It is a lot easier when you have a well-respected expert stick up for you.

17) KNOW YOU NEITHER CREATED YOUR BABY'S PROBLEMS, NOR CAN YOU CURE THEM. Your job is to give the baby the tools they need. The rest is up to them.

18) FOR THE BABY THAT HAS NOT YET ENTERED YOUR HOME – when you get that baby, get a piece of clothing or blanket unwashed and used recently by the primary caregiver. The smell will help the move. And don't you wash it!! Keep it close to the baby to help the baby adjust. No matter the baby's age or living conditions, the move to you is not easy. Never push this object, but make it available.

19) HELP YOUR BABY WITH A TRANSITIONAL OBJECT. This is a blanket or soft toy they can sleep with, use it in the car seat, and for the RARE time you cannot be with them. Helps in security.

21) IF YOU DO ALL OF THESE WITH LOVE AND KINDNESS AND THINGS GET WORSE OR REMAIN THE SAME, GET HELP.

Arthur Becker-Weidman, CSW-R, PhD.DABPS received his doctorate in Human Development from the University of Maryland, Institute for Child Study. He achieved Diplomate status from the American Board of Psychological Specialties in Child Psychology and Forensic Psychology. He is a member of the American College of Forensic Examiners.

Dr. Becker-Weidman has over twenty years experience as a family therapist, consultant, and researcher. He has directed mental health, addiction treatment, family service, and other behavioral health organizations.

Dr. Becker-Weidman has extensive experience counseling families and helping them through difficult times with practical advice. He has published over a dozen scholarly papers and presented at numerous national, regional, and local professional meetings. Much of his research and publications have focused on adolescent and adoptive family development.